scholarly journals Clinical symptoms and treatment of common respiratory tract infections in relation to microbiological profiles in rural health facilities in China: implications for antibiotic stewardship

2020 ◽  
Author(s):  
Xingrong Shen ◽  
Jilu Shen ◽  
Yaping Pan ◽  
Jing Cheng ◽  
Jing Chai ◽  
...  
Keyword(s):  
Respiratory Tract ◽  
Antibiotic Stewardship ◽  
Bacterial Infections ◽  
Respiratory Tract Infections ◽  
Rural China ◽  
Clinical Manifestations ◽  
Antibiotic Use ◽  
Anhui Province ◽  
Presenting Symptoms ◽  
Tract Infections

Abstract Background This study aims to identify the extent to which current clinical practice in the treatment of common respiratory tract infections (RTIs) is consistent with presenting symptoms and microbiological characteristics at health care settings in rural Anhui Province and implications for future antibiotic stewardship. Methods The study was implemented in one village clinic and one township health center in each of four rural residential areas in Anhui Province, China. Observations, structured and semi-structured interviews in village clinics and township health centers were conducted to investigate antibiotic use. Sputum and throat swabs were collected for bacterial culture and susceptibility testing. Results A total of 1068 (51.0% males and 49.0% females) completed the study. Antibiotics were prescribed for 87.8% of RTI patients. Of all the specimens tested, 329 (30.8%) specimens were isolated with bacteria. The most frequently detected bacteria were K. pneumonia (24.15% in all specimens), H. influenza (16.19%), H. parainfluenzae (14.77%), S.aureus (5.11%), M. catarrhalis (3.41%) and S. pneumoniae (2.27%). The bacteria detection was associated with age (OR = 1.91), season (OR = 0.41 to 0.60), days since infection onset (OR = 1.54 to 1.81), and runny or blocked nose (OR = 1.39 to 1.61), cough with green or white sputum (OR = 1.47 to 1.59). Antibiotic use was only linked with limited non-specific clinical manifestations e.g., days since infection onset (OR = 0.53) and sore throat (OR = 1.64). Conclusions The study reveals that antibiotics prescription is still very common in rural China which is driven mainly by patient reassurance and other non-pathological factors rather than treatment of bacterial infections. The study establishes the feasibility of conducting microbiological testing outside Tier 2 and 3 hospitals in rural China.

scholarly journals Clinical symptoms and treatment of common respiratory tract infections in relation to microbiological profiles in rural health facilities in China: implications for antibiotic stewardship

2020 ◽  
Author(s):  
Xingrong Shen ◽  
Jilu Shen ◽  
Yaping Pan ◽  
Jing Cheng ◽  
Jing Chai ◽  
...  
Keyword(s):  
Respiratory Tract ◽  
Antibiotic Stewardship ◽  
Bacterial Infections ◽  
Respiratory Tract Infections ◽  
Clinical Symptoms ◽  
Rural China ◽  
Clinical Manifestations ◽  
Antibiotic Use ◽  
Presenting Symptoms ◽  
Tract Infections

Abstract Background: This study aims to identify the extent to which current clinical practice in the treatment of common respiratory tract infections (RTIs) is consistent with presenting symptoms and microbiological characteristics at health care settings in rural China and implications for future antibiotic stewardship.Methods: The study was implemented in one village clinic and one township health center in each of four rural residential areas in Anhui Province, China. Observations, structured and semi-structured interviews were conducted to investigate antibiotic use. Sputum and throat swabs were collected for bacterial culture and susceptibility testing.Results: A total of 1068 completed the study. Antibiotics were prescribed for 87.8% of RTI patients. Of all the specimens tested, 329 (30.8%) specimens were isolated with bacteria. The most frequently detected bacteria were K. pneumonia (24.15% in all specimens), H. influenza (16.19%), H. parainfluenzae (14.77%), S.aureus (5.11%), M. catarrhalis (3.41%) and S. pneumoniae (2.27%). The bacteria detection was associated with age (OR=1.91), season (OR=0.41 to 0.60), days since infection onset (OR=1.54 to 1.81), and runny or blocked nose (OR=1.39 to 1.61), cough with green or white sputum (OR=1.47 to 1.59). Antibiotic use was only linked with limited non-specific clinical manifestations e.g., days since infection onset (OR=0.53) and sore throat (OR=1.64).Conclusions: The study reveals that antibiotics prescription is still very common in rural China which is driven mainly by non-pathological factors rather than treatment of bacterial infections. The study establishes the feasibility of conducting microbiological testing outside Tier 2 and 3 hospitals in rural China.

scholarly journals Clinical Symptoms and Treatment of Common Respiratory Tract Infections in Relation to Microbiological Profiles in Rural Health Facilities in China: Implications for Antibiotic Stewardship

2020 ◽  
Author(s):  
Xingrong Shen ◽  
Jilu Shen ◽  
Yaping Pan ◽  
Jing Cheng ◽  
Jing Chai ◽  
...  
Keyword(s):  
Respiratory Tract ◽  
Antibiotic Stewardship ◽  
Bacterial Infections ◽  
Respiratory Tract Infections ◽  
Clinical Symptoms ◽  
Rural China ◽  
Clinical Manifestations ◽  
Antibiotic Use ◽  
Presenting Symptoms ◽  
Tract Infections

Abstract Background This study aims to identify the extent to which current clinical practice in the treatment of common respiratory tract infections (RTIs) is consistent with presenting symptoms and microbiological characteristics at health care settings in rural China and implications for future antibiotic stewardship.Methods The study was implemented in one village clinic and one township health center in each of four rural residential areas in Anhui Province, China. Observations, structured and semi-structured interviews were conducted to investigate antibiotic use. Sputum and throat swabs were collected for bacterial culture and susceptibility testing.Results A total of 1068 completed the study. Antibiotics were prescribed for 87.8% of RTI patients. Of all the specimens tested, 329 (30.8%) specimens were isolated with bacteria. The most frequently detected bacteria were K. pneumonia (24.15% in all specimens), H. influenza (16.19%), H. parainfluenzae (14.77%), S.aureus (5.11%), M. catarrhalis (3.41%) and S. pneumoniae (2.27%). The bacteria detection was associated with age (OR=1.91), season (OR=0.41 to 0.60), days since infection onset (OR=1.54 to 1.81), and runny or blocked nose (OR=1.39 to 1.61), cough with green or white sputum (OR=1.47 to 1.59). Antibiotic use was only linked with limited non-specific clinical manifestations e.g., days since infection onset (OR=0.53) and sore throat (OR=1.64).Conclusions The study reveals that antibiotics prescription is still very common in rural China which is driven mainly by non-pathological factors rather than treatment of bacterial infections. The study establishes the feasibility of conducting microbiological testing outside Tier 2 and 3 hospitals in rural China.

Impact of an Antibiotic Stewardship Program on Antibiotic Prescription for Acute Respiratory Tract Infections in Children: A Prospective Before-After Study

2019 ◽  
Vol 58 (11-12) ◽  
pp. 1166-1174 ◽  
Author(s):  
Nalinee Aoybamroong ◽  
Worawit Kantamalee ◽  
Kunlawat Thadanipon ◽  
Chonnamet Techasaensiri ◽  
Kumthorn Malathum ◽  
...  
Keyword(s):  
Respiratory Tract ◽  
Antibiotic Stewardship ◽  
Respiratory Tract Infections ◽  
Instant Messaging ◽  
Antibiotic Prescription ◽  
Antibiotic Use ◽  
Acute Respiratory Tract Infection ◽  
Stewardship Program ◽  
Tract Infections ◽  
E Mail

We assessed the effectiveness of an antibiotic stewardship program (ASP) on antibiotic prescriptions for acute respiratory tract infection (ARTI) in a medical school. Our ASP included delivering an antibiotic use guideline via e-mail and LINE (an instant messaging app) to faculty staff, fellows, and residents, and posting of the guideline in examination rooms. Medical records of pediatric patients diagnosed with ARTI were reviewed to assess the appropriateness of antibiotic prescription. ASP could increase the rate of appropriateness from 78% (1979 out of 2553 visits) to 83.4% (2449 out of 2935 visits; P < .001). The baseline of appropriateness was higher in residents (95%) compared with fellows (82%) and faculty staff (75%). The ASP significantly increased the appropriateness only in faculty staff, especially in semiprivate clinics (75% to 83%, P < .001). In conclusion, our ASP increased appropriateness of antibiotic prescriptions for ARTI, with the greatest impact among faculty staff in semiprivate clinics.

scholarly journals Utility of FebriDx in early identification of possible COVID19 infection

2020 ◽  
Author(s):  
Nawazish Karim ◽  
Muhammad Zubair Ashraf ◽  
Muhammad Naeem ◽  
Tahir Anwar ◽  
Hnin Aung ◽  
...  
Keyword(s):  
Respiratory Tract ◽  
Bacterial Infections ◽  
Respiratory Tract Infections ◽  
Point Of Care ◽  
Protein A ◽  
Simultaneous Detection ◽  
Clinical Manifestations ◽  
Molecular Testing ◽  
Delay In Diagnosis ◽  
Tract Infections

Abstract Background Reliable differentiation between uncomplicated and self-limiting acute respiratory tract infections (ARIs) and more severe bacterial respiratory tract infections remains challenging, due to the non-specific clinical manifestations in both systemic bacterial or viral infections. The current COVID-19 pandemic is putting extraordinary strain on healthcare resources. To date, molecular testing is available but has a long turnaround time and therefore cannot provide results at the point-of-care, leading to a delay in results thereby exposing patients to cross-infection and delay in diagnosis (1-3). Methods We prospectively evaluated the utility of FebriDx®, a point-of-care fingerstick blood test that can differentiate viral from bacterial ARIs through simultaneous detection of both Myxovirus-resistance protein A (MxA) and C-reactive protein (CRP), in rapidly determining viral cases requiring immediate isolation and confirmatory molecular testing, from non-infectious patients or bacterial infections that require antibacterial therapy.Results 75 consecutive patients were assessed and 48 eligible cases were tested with FebriDx®. Overall, 35 patients had FebriDx® test viral positive. All 35 patients had either positive rt-PCR (n=30) for COVID-19 or clinical picture highly suggestive of COVID-19 infection (PPV of 100% in a pandemic situation)[AB1] . In the 13 cases it was viral negative, rRT-PCR was also negative in all cases. In one case of LRTI, it was not possible to determine the exact cause of infection and a viral infection couldn’t be excluded. Including this patient, the NPV was 12/13 (92%) exceeding the NPV of rRt-PCR at 71% (12/17). Sensitivity was conservatively calculated at 97% (35/36) compared to 85.7% (30[RS2] /35) for rRt-PCR. Similarly the specificity of both FebriDx®and rRt-PCR was 100% (12/12).Conclusions In the current COVID-19, FebriDx® shows potential as a reliable POC test and a proxy marker of COVID-19 infection amongst inpatients in a secondary care setting. [AB1]35/35 equates to a sensitivity and specificity of 100% for COVID, would you be willing to say that instead of ‘near 100% ppv)? [RS2]I believe PCR was 85.7% (30/35), because PCR only detects the COVID cases

Leveraging Existing and Soon-to-Be-Available Novel Diagnostics for Optimizing Outpatient Antibiotic Stewardship in Patients with Respiratory Tract Infections

2020 ◽  
Author(s):  
Kelly A Cawcutt ◽  
Robin Patel ◽  
Jeff Gerber ◽  
Angela M Caliendo ◽  
Sara E Cosgrove ◽  
...  
Keyword(s):  
Infectious Diseases ◽  
Respiratory Tract ◽  
Antibiotic Stewardship ◽  
Bacterial Infections ◽  
Respiratory Tract Infections ◽  
Future Research ◽  
Antibacterial Resistance ◽  
Research Needs ◽  
Effective Implementation ◽  
Tract Infections

Abstract Respiratory tract infections (RTIs) drive many outpatient encounters and despite being predominantly viral, are associated with high rates of antibiotic prescriptions. With rising antibacterial resistance, optimization of prescribing of antibiotics in outpatients with RTIs is a critical need. Fortunately, this challenge arises at a time of increasing availability of novel RTI diagnostics to help discern which patients have bacterial infections warranting treatment. Effective implementation of antibiotic stewardship is needed, but optimal approaches for ambulatory settings are unknown. Future research needs are reviewed in this summary of a research summit convened by the Infectious Diseases Society of America in the fall of 2019.

scholarly journals How reliable is procalcitonin as an inflammatory marker?1)

2012 ◽  
Vol 35 (6) ◽  
pp. ---
Author(s):  
Katharina Biller ◽  
Peter Fae ◽  
Reinhard Germann ◽  
Autar K. Walli ◽  
Peter Fraunberger
Keyword(s):  
Intensive Care ◽  
Diagnostic Tool ◽  
Plasma Levels ◽  
Bacterial Infections ◽  
Respiratory Tract Infections ◽  
Inflammatory Marker ◽  
Antibiotic Use ◽  
Intensive Care Patients ◽  
Tract Infections

Abstract The role of procalcitonin (PCT) plasma levels as a diagnostic tool for intensive care patients has been intensively investigated during the past years. In particular for recognition of bacterial infections, PCT levels have been shown to be superior to other clinical and biochemical markers. Furthermore, some very recent studies show that in patients with lower respiratory tract infections PCT guided antibiotic therapy reduces antibiotic use and thereby may also reduce duration of stay of patients in hospital and thus cut hospitalisation costs. However, various studies indicate that the value of PCT as a prognostic marker is limited because of false positive or negative values. Despite these limitations PCT plasma levels are currently measured in intensive care units. The present study summarises the possible clinical uses of this laboratory marker as a diagnostic tool for the assessment of critically ill patients.

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